MEDICARE: MRS. CORNELIA ALICE GRIFFIN N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	ARNP3247842	FL

General Provider Information

NPI Number	:	1508850645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORNELIA ALICE GRIFFIN N.P.

Provider Business Mailing Address
First Line	:	2007 S PENINSULA DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32118-5213
Country	:	US
Telephone Number	:	386-255-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 S PENINSULA DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32118-5213
Country	:	US
Telephone Number	:	386-255-0076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2005
Last Update Date	:	07/08/2007

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